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St. Vincent Healthcare
St. Vincent Healthcare patient John Senn talks with Dr. Barry Winton inside the hospital on Nov. 30. Winton performed a ministernotomy to replace Senn’s aortic valve in September.

At the end of November, John Senn was out and about in his wheelchair.

Senn, of Billings, considers himself lucky — he could easily still be bedridden in the hospital after his surgery to repair an aortic valve in his heart on Sept. 23.

But due to some quick thinking by Dr. Barry Winton, a cardiovascular and thoracic surgeon at St. Vincent Healthcare, Senn was out of the hospital four days later.

Senn has hereditary spastic paraplegia, an inherited neurological disorder characterized by progressive weakness and stiffness in the legs. He calls his condition an “orphan disease” because it affects only about 20,000 people in the United States.

After walking with a cane for several years, Senn began using a wheelchair regularly about two to three years ago.

Senn’s heart disease, though, was fairly asymptomatic. He initially went in to have a heart murmur checked, and tests determined a bad aortic valve would lead to the onset of congestive heart failure.

The standard treatment for someone with Senn’s condition is open heart surgery through the breastbone.

“The problem with that,” said Winton, “is you have to wire the sternum back together, which requires a 10-week recovery.”

Winton explained that open heart surgery for a patient in a wheelchair can present a real problem.

“It’s significant, because there is so much pressure on the chest getting in and out of a wheelchair,” he said.

So Winton decided to replace Senn’s aortic valve with a “ministernotomy.”

Basically, instead of making a footlong incision and cracking open the sternum to gain access to the heart, Winton made an incision of about 4 inches in his patient’s upper chest.

“Everything about the surgery is basically the same,” he said. “But the exposure to the heart isn’t as good. It’s much more challenging technically.”

Winton had done maybe a dozen heart surgeries in this same fashion about a decade ago and has since obtained even more training, plus his own experience in the operating room.

“This type of surgery was popular about 10 years ago, and then fell out of favor due to lack of benefits for the patient,” Winton said. “It takes about the same about of time (three hours), but there’s less margin for safety.”

Now, Winton has better technology and medical equipment on his side.

The minimally invasive valve surgery is not an approach he would use for everybody, and Winton considers it one of many tools in his toolbox.

But for a patient in a wheelchair, the benefits — including early mobilization and a faster return to full activity — to this less invasive surgery were obvious.

Winton said many bedridden patients don’t respond well, suffering from major depression, bed sores and staph infections. He hopes to use this type more in the future, for heart operations that will allow it, such as an isolated valve surgery like Senn’s.

Winton expects Senn’s heart will return to being fully functioning.

“I had friends tell me I would have to leave Montana to get good care, but I think we get the cream of the crop right here,” Senn said. “Dr. Winton totally blew me away with all the different things he thought of as far as me being in a wheelchair.

“He went that extra mile.”

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